Malignancies of the external auditory canal and temporal bone: a review.

BACKGROUND: Malignancies of the external auditory canal and temporal bone are uncommon. A retrospective review was conducted of a large series treated at the Prince of Wales hospital between 1974 and 1995. METHODS: Retrospective review of 59 cases of ear canal and temporal bone malignancies. These were analysed according to histopathology, disease extent, surgery, margin status and survival. A TNM-type staging system was applied to 51 cases and Kaplan-Meier survival analysis applied to this group. RESULTS: The 5-year cancer-specific survival (CSS) for the series was 54%. For stages 1, 2, 3 and 4 disease, the CSS were 90, 45, 40 and 19%, respectively. Survival was significantly higher where clear surgical margins were achieved (80 vs 35%). CONCLUSIONS: Carcinoma of the external ear canal is rare and, in Australia, is often related to recurrence of periauricular cutaneous malignancy. Surgical extirpation with clear margins provides the best survival.

The scapular osteofasciocutaneous flap: a 12-year experience.

OBJECTIVE: To elucidate the factors that play a role in the decision-making process to use the scapular donor site, we have reviewed our 15-year experience with 57 clinical cases, to our knowledge the largest case series to date. DESIGN: Retrospective, single-surgeon medical record review. PATIENTS AND METHODS: Retrospective review of 57 consecutive cases (53 patients) involving mandibular and maxillary reconstruction using bone-containing scapular free flaps over a 15-year period. Composite flap composition as well as donor and recipient site complications were recorded. RESULTS: Forty-one reconstructions were performed for mandibular defects, 11 were performed for maxillary defects, and 5 for combined defects involving the mandible and maxilla. Seven flaps were composed of 2 separate bone flaps using the angular branch and the circumflex scapular artery. A total of 6 flaps were failures in 5 patients, giving an overall success rate of 89%. CONCLUSIONS: The subscapular system of flaps is a versatile donor site that offers distinct advantages in the older patient population as well as in patients with a preexisting gait disturbance. It is particularly advantageous in patients requiring a large surface area of soft tissue to restore their defect.

Advanced patient age should not preclude the use of free-flap reconstruction for head and neck cancer.

BACKGROUND: Microvascular free flaps have become the principal form of reconstruction after the radical excision of head and neck malignancies at Royal Prince Alfred Hospital, Sydney. This surgery is time consuming, complex, and may be regarded as inappropriate in some elderly patients. This paper examines whether or not elderly patients (aged 70 years and older) are unduly disadvantaged by this form of reconstruction in the management of head and neck malignancy. PATIENTS AND METHODS: Two groups of patients were retrospectively studied: 26 patients aged 70 years or older (group 1) and 91 patients aged less than 70 years (group 2). All patients had a free-flap reconstruction after radical excision of head and neck malignancies between 1987 and 1993. The anatomic distributions of cancers and clinical stages were similar in both groups. The two groups were examined for preoperative medical risk factors, postoperative complications, length of hospital stay, and ability to tolerate an oral diet. RESULTS: In group 1, 81% of patients had at least 1 preoperative risk factor, with 42% cardiac and 27% respiratory risks. In group 2, 51% of patients had preoperative risks, 11% cardiac and 22% respiratory. Postoperatively, 42% of patients in group 1 had surgical complications, versus 37% in group 2. Postoperative medical complications were 54% in group 1 and 29% in group 2. Median hospital stay was 22 and 23 days, respectively. CONCLUSION: There was no statistical difference in the postoperative surgical complication rates, and, when stratified for premorbid factors, the overall postoperative complication rates between the two groups were also not statistically significantly different. This suggests that age alone should not exclude a patient from radical surgery for head and neck cancer with free-flap repair.

Plunging ranula: literature review and report of three cases.

Three cases of plunging ranula are described and the literature is reviewed. In many cases, a plunging ranula is iatrogenic and follows surgery to an oral ranula. In the cases presented, the cervical swelling was associated with prolongations of sublingual gland into or through the mylohyoid muscle. All patients were cured by partial or total excision of the sublingual gland.

Blocked, runny or stuffy nose.

The blocked, runny or stuffy nose is purely a symptom caused by a multitude of complaints. Whether the discharge be serous or mucoid is not necessarily important, but more so is the transition from mucoid to purulent. Where signs and symptoms of so many causative pathological agents are so similar, a better understanding of nasal function coupled with a more thorough examination of the nasal cavity and indeed of the whole patient, is the only way to come to an accurate diagnosis.